What is healthcare for?

Abstract

Why this matters to me I find the lack of clarity about the fundamental purpose of health care which causes moral conflict and inappropriate clinical activity, damaging clinicians and patients alike, very disturbing. use, distribution, and reproduction in any medium, provided the original work is properly cited. What is medical ethics? If you read the newspapers or listen to Radio 4 you would get the impression that medical ethics is the discussion of moral problems posed by modern medical technology or bizarre situations – whether and when it is permissible to turn off life support machines [1], the implications of ever more sophisticated techniques in assisted conception [2] or whether to amputate a normal leg because the patients asks for it [3]. This I call 'tabloid ethics'. If you work in primary health care however you will know that most ethical problem which practitioners face are not caused by cutting edge technology or extraordinary situations, but by the normal messy complexities of human life and relationships. Exactly what do you write and how do you phrase it when asked about a health problem in a medical report which may affect someone's insurance, mortgage or job?[4] How hard should you try (if at all) to persuade someone with a high cholesterol of the benefits of statins? How do you handle information which you obtain from one person in confidence which has implications for the health or well-being of someone else? Although they still do not get the attention they deserve, there is increasing recognition within the health professions, if not in the media, of the importance of these and the many other questions which make up 'everyday ethics' [5] or 'the ethics of the ordinary' [6], and there are conferences, workshops, books, journal articles and websites [7] which try to help practitioners deal with them. However, a more fundamental question even more rarely discussed underlies both tabloid and everyday ethics. What is health care for? We spend lots of time and money making sure our practice is as efficient and evidence based as possible, but rarely stop to consider why we do what we do. Many people would say the answer was obvious: saving lives and preventing or relieving pain and suffering. But lives are never saved. Mortality remains 100%, and death is merely postponed. An expression originally used to refer to saving someone from drowning or other sudden traumatic death …